Using Evidence-Based Quality Improvement Methods for Translating Depression Collaborative Care Research Into Practice

Lisa V. Rubenstein, Edmund F. Chaney, Scott Ober, Bradford Felker, Scott E. Sherman, Andy Lanto, Susan Vivell

Research output: Contribution to journalArticle

Abstract

Objective: Translating Initiatives in Depression into Effective Solution (TIDES) aimed to translate research-based collaborative care for depression into an approach for the Veterans Health Administration (VA). Sites: Three multistate administrative regions and seven of their medium-sized primary care practices. Intervention: Researchers assisted regional leaders in adapting research-based depression care models using evidence-based quality improvement (EBQI) methods. Evaluation: We evaluated model fidelity and impacts on patients. Trained nurse depression care managers collected data on patient adherence and outcomes. Results: Among 72% (128) of the 178 patients followed in primary care with depression care manager assistance during the 3-year study period, mean PHQ-9 scores dropped from 15.1 to 4.7 (p < 001). A total of 87% of patients achieved a PHQ-9 score lower than 10 (no major depression). 62% achieved a score lower than six (symptom resolution). Care managers referred 28% (50) TIDES patients to mental health specialty (MHS). In the MHS-referred group, mean PHQ-9 scores dropped from 16.4 to 9.0 (p < 001). A total of 58% of MHS-referred patients achieved a PHQ-9 score lower than 10, and 40%, a score less than 6. Over the 2 years following the initial development phase reported here, national policymakers endorsed TIDES through national directives and financial support. Conclusions: TIDES developed an evidence-based depression collaborative care prototype for a large health care organization (VA) using EBQI methods. As expected, care managers referred sicker patients to mental health specialists; these patients also improved. Overall, TIDES achieved excellent overall patient outcomes, and the program is undergoing national spread.

Original languageEnglish (US)
Pages (from-to)91-113
Number of pages23
JournalFamilies, Systems and Health
Volume28
Issue number2
DOIs
StatePublished - Jun 1 2010

Keywords

  • Collaborative care
  • Depression
  • Evaluation
  • Implementation
  • Quality improvement

ASJC Scopus subject areas

  • Applied Psychology
  • Psychiatry and Mental health

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